Provider Demographics
NPI:1275780264
Name:HASSANIZADEH, YASAMAN
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:HASSANIZADEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12271 LA MIRADA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1336
Mailing Address - Country:US
Mailing Address - Phone:562-944-8408
Mailing Address - Fax:
Practice Address - Street 1:12271 LA MIRADA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1336
Practice Address - Country:US
Practice Address - Phone:562-944-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA575831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry